Generous — and inclusive — sick leave is a must for any business that wants to reopen safely

• As businesses reopen, employers are scrambling to develop effective screening strategies for potentially infected employees.
• But there's one major problem: workers may not get paid time off if they're sent home — and may not honestly answer questions about symptoms and exposure.
• Employers need to offer effective and generous sick leave to safely return to the office.

As states across the country reopen for business, employers of all sizes have scrambled to develop prework screening protocols to identify and exclude infected employees from the workplace. The CDC has endorsed this strategy in its first formal guidelines for reopening employers.

There is one major problem: Screening works only if employees report their symptoms and exposure history honestly.

But for millions of workers, this could mean significant time off without pay. To paraphrase the old saying, it is difficult to get people to answer honestly when their salary depends upon not answering honestly.

The logical solution is more generous and flexible sick leave. Paying potentially infected employees to stay home is not cheap, but the alternatives — workplace outbreaks leading to absenteeism, extended shutdowns, and possible legal liability — are likely to cost even more. To a rare degree, the interests of employers, employees, and the broader public are aligned.When infected employees are forced to report to work by financial necessity, everyone loses.

To see why, think about how the new CDC guidelines will operate in practice. When employees report to work each day, employers will take their temperatures and ask them a series of simple screening questions.

Do they have a cough, shortness of breath, loss of smell or taste, or other common symptoms of COVID-19? Have they been exposed to anyone suffering from these symptoms or anyone who has tested positive for COVID-19? And so on.

Armed with this information, employers will stand an excellent chance of identifying and excluding most infected employees before they enter the workplace. But only if the information is truthful and accurate.

Now consider the perspective of workers. The vast majority will want to answer questions truthfully. Very few will want to expose their colleagues or customers to additional risk. But it won't take long for people to realize that answering "yes" gets them sent home from work for multiple days — maybe longer.

As cold and flu season approaches, some employees maybe sent home repeatedly for symptoms that turn out not to be COVID-19 — or for simply living with someone who is experiencing such symptoms. Without generous and flexible paid sick leave, the pressure to fib or withhold information will be enormous. Even before the pandemic, the Federal Reserve reported that 40% of US adults would be unable to meet an unexpected expense of $400. As the economic crisis worsens, financial pressure not to miss work will only increase.

Of course, thermometers do not lie. But a growing body of evidence indicates that temperature screening is a highly imperfect method of detecting coronavirus infections. So long as blood or body fluid testing remains impractical, the best basis for screening, by far, is honest self-reporting of symptoms and exposure. Sick leave gives employees the economic incentives necessary for this system to work, protecting their colleagues and employers alike: It is the epitome of a win-win solution.

Effective sick leave policies will vary in detail but share five essential features.

• First, leave must extend not just to employees experiencing symptoms or caring for loved ones, but also to those who are likely to have been exposed to the virus.
• Second, sick pay must be sufficiently generous to eliminate any significant financial pressure for employees to come to work when they shouldn't.
• Third, limits on the duration of leave should be relaxed or abandoned for the length of the COVID-19 pandemic.
• Fourth, the process for claiming sick leave should be streamlined as much as possible.
• Fifth, employees returning from sick leave must be medically cleared for work.

Mandatory medical follow-up will help to curtail abuse. As additional security, extended sick pay might be set slightly below regular pay. But if the gap is too large, some employees who should stay home will not, at great cost to their colleagues and employers.

In the CARES Act, Congress has already taken limited steps to fund better paid sick leave. Given the public-health and economic interests at stake, it should do far more. But even without additional government funding, better sick leave may well prove the cheapest and most effective way for many employers to avoid widespread absenteeism, costly shutdowns, and legal liability for workplace infections. No return-to-work plan is complete without it.

Marvin J. Slepian, MD, is Regents' Professor of Medicine and Biomedical Engineering at the University of Arizona.

James Coan is Chief Strategy Officer at Remedy, a Texas-based provider of on-demand urgent care services to employer health plans.

Andrew Coan is a law professor at the University of Arizona.